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The Playbook for Building Win-Win Startup Partnerships

Todd Dunn, Director of Innovation, Intermountain Healthcare, Inc.

Santosh Mohan, Member, HIMSS Innovation Committee

Innovation Preconference Symposium Session INV4, February 11, 2019

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Today’s Speakers

Santosh Mohan, MMCi FHIMSS

Member HIMSS Innovation Committee

Twitter: @santoshSmohan

Todd Dunn

Director of Innovation

Intermountain Healthcare, Inc.

Twitter: @TToddDunn

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Todd Dunn

Has no real or apparent conflicts of interest to report.

Santosh Mohan, MMCi, CPHIMS, FHIMSS

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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• Discuss needs and sustainable approaches for engaging

entrepreneurs to delve into improvement opportunities

• Examine tools and approaches for rapidly identifying and

assessing high performing technology partnerships through

streamlined decision-making

• Explore ways to structure a startup partnership with shared vision,

success metrics, and sense of urgency to drive mutual success

• Review top tactics to identify champions, consider integration

elements, address dependencies, and overcome biggest adoption

hurdles

Learning Objectives

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AcknowledgementsClayton Christensen

Boston, MA

Intermountain Healthcare

Salt Lake City, UT

Bert Zimmerli

Chief Finance Officer

Marc Probst

Chief Information Officer

Kevan Mabbutt

Chief Consumer Officer

Rock Health

San Francisco, CA

Venture Valkyrie

Mill Valley, CA

Lisa Suennen

The Re-Wired Group

Detroit, MI

Bob Moesta

athenahealth

Watertown, MA

Michael Palantoni

Executive Director, Platform Strategy And Operations

Atrium Health

Charlotte, NC

Rasu Shrestha

Executive Vice President and Chief Strategy Officer

AVIA

Chicago, IL

Brigham Digital Innovation Hub

Boston, MA

Adam Landman, MD, MS, MIS, MHS

Chief Information Officer, Brigham Health

Josie Elias

Program Manager

Mark Zhang DO, MMSc

Medical Director

Chen Cao

Innovation Analyst

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7Yaw Pitch Roll

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9

Source: AHA and AVIA Digital Innovation Report 2017

Digital Innovation a top priority

85%

75%

76%

75%

“ …a priority at our health system”

“ …tied to our long-term strategy”

“…essential to meeting long-term goals

and metrics”

“…pursuing it is necessary for a

competitive advantage”

10

76%leaders believe that innovation includes partnering with other innovative

organizations

42%leaders believe that innovation includes testing and scaling externally-

developed digital solutions made by small to medium-sized solution companies

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Direct startup

partnerships

Events

(hackathons, pitch

competitions,

demo days etc.)

Incubators and

accelerators

External

partnerships

Startup

investments

Co-Working

spaces and labs

Co-development,

APIs, App Stores

Acquisitions

and spin-offs

12

Key ChallengesDivergent Risk Profiles

Differing Motivations

Distinct Cultures

Complex Regulations

13

14

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Who to Blame

Frederick Winslow Taylor

(1856 – 1915)

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“Jobs-to-be-done offers a clear way

to innovate.”

Clay Christensen, HBS

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18

Three C’s of Design Disease

Conference Rooms

Conference Calls

Cubes

Context (their Cambodia)

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Three core principles

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21

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Key Partnerships Key Activities Value Proposition Customer Relationships

Customer Segments

Key Resources Channels

Cost Structure Revenue Streams

DESIRABILITY: CUSTOMER

DEVELOPMENTFEASIBILITY:

BUILD, BORROW, BUY?

VIABILITY

SANITY CHECK

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Value Proposition Canvas

24

25

What

you

do

26

27

28

HEALTHCARE SHIFT TO FEE FOR VALUE

29

30

31

12345

Vague success metrics

Open-ended sponsor roles

Failure to understand operational realities

Runaway vaporware

Poor contracts lacking long-term commitment

Innovative

technologies

$New revenue streams

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“We should be the partner of

choice for innovators across the

digital health landscape.”

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Innovation

Ble

edin

g E

dge

Sett

led

ScaleResearcher/Clinic Hospital-wide

2-3 Departments

Integrating novel

w/existing

System-wide

Stable tech

1-2 clinics

Advancing ideas

Key factors for translating pilots to implementation

Source: Tseng, Jocelyn, et. al. “Catalyzing Healthcare Transformation

with Digital Health: Performance Indicators and Lessons Learned from

a Digital Health Innovation Group.” Healthcare, 25 Sept. 2017.

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The DHIG governance process reduces risk for both individual projects and

for the broader organization, improving the likelihood success by ensuring

proper approvals and best practices are followed.

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Rev 1.4 – May 15, 2017

Digital Health Innovation Guide (DHIG) Checklist

Requirement Description Assets

Co

ntr

actin

g &

Le

ga

l

Business Associate Agreement (BAA)

Agreement between the vendor and subcontractors who will be performing a service on behalf of the institution and will have access to patient health information

(protected health information or “PHI”).

Brigham and Women’s Hospital (BWH) standard BAA template*

Statement of Work (SOW) Agreement between innovator and vendor as to pilot scope. Used for contracting

purposes and must be signed off by supply chain for a PO to be issued. Substantial

modifications or enhancements to develop

should consider a new SOW.

Partners HealthCare System (PHS) standard SOW template*

Support for Product During

Pilot

It is the application owner's responsibility

to provide application support for all users.

Discuss with your client how you will manage issues and turnaround time.

Terms and Conditions (T&C) Review

T&C for patients and other users must be approved by client's legal.

Sample T&C document*

Ma

rke

tin

g

& P

ub

lic

Aff

air

s

Reference Hospital in

Marketing/PR

Approval for any planned project PR must

be discussed with hospital in advance. There can be limits on how to incorporate

hospital in marketing/PR.

Pu

blis

hin

g

Re

su

lts

Research or Quality

Improvement (QI) Submission

Pilots need to determine if an IRB review is

required for research purposes or if the proposed activity is clinical quality

improvement/measurement, in which case IRB review is not required. If a pilot is

research, then the IRB approval must be

complete prior to launch. This should also be included in the SOW.

Clinical Quality Improvement

checklist*

Se

cu

rity

Security Risk Assessment Security review of the app to ensure that it will be safe within hospital environment.

This is also where HIPAA compliance is

addressed.

BWH IS standard vendor cybersecurity risk assessment

form*

Security Scans A subcomponent of the risk assessment:

May include Veracode and Qualys scans,

depending on product design.

CHECKLIST-DRIVEN PROCESS

Pre-approved/customizable guardrails and

regular check-ins keep projects on track

CROSS-FUNCTIONAL GUIDANCE

Information Security, Partners eCare,

Compliance, IRB, Partners Innovation and

other teams

PROJECTS

REVIEWED100+ AVERAGE TIME FROM

INTAKE TO PILOTFOR PROJECTS WHICH ULTIMATELY

EXECUTED A PILOT

9 MONTHS

IMPACT TO DATE

Digital Health Innovation Guide (DHIG)

Source: Tseng, Jocelyn, et. al. “Catalyzing Healthcare Transformation with Digital Health: Performance

Indicators and Lessons Learned from a Digital Health Innovation Group.” Healthcare, 25 Sept. 2017.

DHIG Supported Implementation Pathway

Project-Based Monitoring and Detail Checklists Track for Progress and Pitfalls

Task-level detail

• All items

• Notes/comments

• Assignees

• Resource links

• Task Status

Key project indicators

• Goals

• Contacts

• Task Status

• Issues

• Files

Source: Elias, J., Zhang, H. (2018, March 1).

Telephone interview. Brigham Digital Innovation Hub.

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The pathway to sustainable operations

INNOVATION COORDINATION OPERATION

Early Stage

Ideation

Pilot

Handoff

Assessment

Planning

Support

Scale

Manage

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The AMA is committed to making technology an asset, not a burden, and

the playbook provides the medical community with widespread access to

a proven path for implementing digitally enabled health and care.

Dr. Jesse M. Ehrenfeld, AMA chair elect

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AMA Digital Health Implementation Playbook

Best practices shared by 80+ nationwide physicians, patients, care

team members, administrators, and entrepreneurs

Practical guide leading from identifying the need and forming a team

to contracting to partnering and evaluating the success

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Download the Playbook here:

https://www.ama-assn.org/amaone/ama-digital-health-

implementation-playbook

“Accelerating the pace of digital health adoption requires an

efficient and proven path to success, but best practices are not

widely shared. The Playbook responds to a growing

demand for proven guidance that physicians and care

teams need to successfully integrate effective digital

solutions into practice.”

Michael Hodgkins, MDAMA Chief Medical Information Officer

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Rise of the App Stores of the EHRs

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Cut down integration

costs and

implementation time

Lower investment

and risk

Shopping experience –

choice of similar

functionality within category

Filter signal from noise –

glean from peer reviews

and best practices

Eliminate RFP process Agile pilots – try

before you buy

Benefits of App Stores

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Discussion

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We all need a flight plan

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Develop a standard process

Invest in IT resources

Implement a flexible budget cycle for operations staff

Source: AHA and AVIA Digital Innovation Report 2017

We all need a flight plan

50Source: “Healthcare IT startups have become too willing to accept pilot status,” Lisa Suennen,

MedCityNews, May 2016, available at https://medcitynews.com/2016/05/healthcare-startups-

become-willing-accept-pilot-status/, accessed March 2, 2018; Interviews and research

Think hard about whether

a pilot is really necessaryOnly pilot what you intend to buy

Don’t measure success by

# of pilots; have the right approach

Pay vendors for pilots

Render an early verdict – if it’s clear

the pilot isn’t working, stop it earlyBe honest with yourself about how

much customization you really need

Pilot products are not perfect

– build your own if you

need them to be perfect

Put your A team

on the pit crew

Additional Considerations

Clarify expectations upfront

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Thank you!

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Q&A and Contact Information

Santosh Mohan, MMCi FHIMSS

Member HIMSS Innovation Committee

Twitter: @santoshSmohan

LinkedIn.com/in/santoshmohansantosh.mohan@fuqua.duke.edu

Todd Dunn

Director of Innovation

Intermountain Healthcare, Inc.

Twitter: @TToddDunn

LinkedIn.com/in/dunntoddtodd.dunn@imail.org